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General NPI Number Information
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NPI Number | 1033315569
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Entity Type | Individual
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Provider Name | DR. SUZANNE Y DIB
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 2950 FAIRWAY DR SUITE 2
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City | ALTOONA
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State | PA
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Zip | 16602-4494
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Country | US
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Telephone | 814-942-9494
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Fax | 814-942-4403
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Provider Business Mailing Address
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Address Line | PO BOX 1111
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City | ALTOONA
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State | PA
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Zip | 16603-1111
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Country | US
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Telephone | 814-942-9494
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Fax | 814-942-4403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD440358
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License Number State | PA
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